Author Topic: ICD-10 Begins  (Read 2789 times)

RichardP

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ICD-10 Begins
« on: October 01, 2015, 01:59:08 AM »
Here we go.  Good luck everybody.

Within the last week we have had clients new to us insist that, for the next year, using ICD-10 is optional.  Or, they have been told by other providers that - where one ICD-09 code translates approximately to multiple ICD-10 codes - the provider must use each and every one of the multiple ICD-10 codes or the claim won't get paid.

These are highly-paid doctors in Beverly Hills.  I wouldn't have believed it if I hadn't heard it myself.  Fortunately for them, we set the new clients straight.  Hopefully, they are passing the correct information back to those they heard the incorrect information from.

This next year is going to be interesting.

For one last time, for those who might need it, here is a resource that is quite good.

http://www.icd10data.com/Convert
Converter

http://www.icd10data.com/ICD10CM/Codes
ICD-10 Diagnosis Codes

http://www.icd9data.com/
Main Page
« Last Edit: October 01, 2015, 02:07:57 AM by RichardP »

Michele

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Re: ICD-10 Begins
« Reply #1 on: October 01, 2015, 08:17:53 AM »
We have also heard some similar crazy information as well.  Someone actually said on Monday "they may delay it again right?"  :)

I'm not anticipating any big issues for us, just a few bumps, but it will be interesting to see how we all do!  I told a couple of my doctors "it's like Y2K, tomorrow we will all wake up and everything will be ok".  Unfortunately there are vulture companies out there trying to get money out of everybody using fear tactics.  One of our smaller clients (one doctor chiropractor who is semi retired) had someone offer to translate all of their patients' diagnosis for them for $2500 down, and the rest of the bill due upon completion. 

Let's keep each other posted.
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kristin

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Re: ICD-10 Begins
« Reply #2 on: October 02, 2015, 04:10:57 PM »
At my office, everything has been business as usual. I made a few extra tweaks to my ICD-10 superbill today, but that was it. That said...

I already see a fairly large problem with my remote billing jobs, in that the various EMR/PM systems I use for them are converting the ICD-9 codes over to ICD-10 codes, and they are all converting to unspecified codes, if multiple more specific codes exist. While I know that there is a one year grace period with CMS for this use of unspecified codes, I don't want the providers to start off on the wrong foot by simply letting the EMR assign an unspecified code, when they should actually be looking for the specific code they need in the system.

I am also surprised all over again at how unprepared/uninformed so many providers/coders/billers were yesterday, based on what I was reading on various forums. I am talking about very basic stuff, that nobody seemed to understand.

One other thing...for the last two years I have been reading articles about how much money it would cost a 1-3 provider practice to make the transition to ICD-10. At one point, I think the high figure was like $50,000. I could never understand why the dollar amount was so high, and in the end, it was crazily inflated. We transitioned for under $1500. Upgraded software, and a mapping book, that was all that was needed. I really hope people didn't get scammed by companies like Michele mentioned in her post.

All in all for me, ICD-10 turned out like Y2K. Much ado about nothing. Now if the insurance companies delay payments, that will be a different story, and remains to be seen.

RichardP

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Re: ICD-10 Begins
« Reply #3 on: October 02, 2015, 06:06:10 PM »
... the various EMR/PM systems I use for them are converting the ICD-9 codes over to ICD-10 codes ...

Kristin - can you provide a bit more detail on that statement please. re. the remote systems:

1.  Are you the one putting in the diagnosis codes?

2.  Or are you talking about a situation where the doctor is placing the codes into the EMR, and the EMR is sending the codes to the PM side?

3.  If Point 2 is the correct answer, are the doctors still using the ICD-9 codes, and letting the EMR translate from 9 to 10 on the fly?

One of our new clients is using the AthenaHealth system.  He puts the codes into the EMR, AthenaHealth's black box does its thing with his codes, and then he has to do the follow-up.  Did the insurance pay?  If yes, was it correctly posted to the proper patient?  Was the correct amount posted?  Does the claim need to be appealed?  He has no desire or expertise to do this work and so he has hired us to do it.  Plus oversee his transition to ICD-10.

AthenaHealth gave us an Excel spreadsheet that we could download which lists the doctor's most frequently-used diagnosis codes, and the ICD-10 code(s) they had translated them to.  We verified that they were all correct.  But also noted a significant number of the codes had translated to unspecified.  That is because the ICD-09 codes were also for unspecified.

Our primary goal was to be as certain as possible that our client could see patients on 10-1 and be confident that the ICD-10 codes he picked would pass through the AthenaHealth system and on to the payors.  We assured him that this would happen, but that we would need to fine-tune his codes over the next few months.  Kristin, it seems you will need to do that also with your remote clients.  Medicare has said that, for the next year, they won't reject codes so long as they are in the correct family of codes, so we have some time to do this.

For all of our clients, over the next few months, we are going to make certain that the ICD-10 unspecified codes remain only in those instances where it is actually the correct choice.  That will be a simple task for the Internal Medicine folks.  Not so easy for the specialists.

The other class of codes we need to tighten up are the ones that have a left/right or top/bottom choice.  For now, Medicare at least will pay on codes that don't specify where on the body.  In 12 months, they will probably reject claims that contain codes that should specify where on the body and don't.  When this happens, I predict a good number of doctors will give up and join doctor's groups where they can just practice medicine and get paid, and leave the coding up to others.

kristin

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Re: ICD-10 Begins
« Reply #4 on: October 02, 2015, 07:47:05 PM »
Richard, here is what I have figured out since I wrote my post, because I went into the EMR's, and did some further digging around(basically I am dealing with Point 2, to Point 3)

Each EMR was upgraded to include every ICD-10 code available. However, the mapping that was done automatically most frequently maps to an unspecified code, because as you say, the ICD-9 codes were unspecified to begin with. Because I bill only for specialists, there are very few codes that have an equivalent mapping available. 99% of them need laterality, A,D,S, or causation factors listed. Gout, for example, went from two codes basically, to over fifty codes. Same with diabetes, ulcers, etc.

The provider enters the superbill through the EMR, and chooses CPT and ICD-10 codes, and assigns them accordingly. I go in to the EMR, look at the superbill, and then transfer the charges manually to a completely separate PM software. But how the EMR superbill is set up is that the provider can just pull up the ICD-9 code that they have always used in the past, and the ICD-10 code that mapped to it is right next to it, so the provider assumes that they don't have to do anything further, the EMR did it for them. Should they want to, they CAN search for a more specific ICD-10 code, and use that one. But that isn't happening. The reason I think it isn't happening is because the providers were assured by the EMR people that "you just need to code ICD-9, and it will convert for you!". In fact, one of the EMR's I use says this on the log-in page:

"Transition to ICD-10 without having to know a single code with our streamlined diagnosis selection". Yeah, great. That just encourages providers to think they will never have to actually learn the codes in any way, because the EMR will handle it.  :-\

So I am now looking at billings that almost exclusively have unspecified ICD-10 codes used, and now I have to talk to the providers, and the owners of the billing companies, and get everyone to understand that this isn't going to work, for the very reasons you stated...while claims won't reject during the grace period, that will change come Oct. 1, 2016. Which is why I want to nip this in the bud now, before the providers get too reliant on the EMR.


RichardP

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Re: ICD-10 Begins
« Reply #5 on: October 03, 2015, 03:33:48 AM »
Kristen - all of us who do billing for specialists have a huge job ahead of us.  I don't think we are going to convince the physicians to figure out how to find the appropriate listing from which they can figure out which code to use.  I'm thinking a different approach is going to be used - like making the biller find the code (which will require access to the doctor's notes).

For those reading who may not understand the magnitude of what Kristen said, here are the choices for Gout.  Remember that this is one diagnosis out of maybe a number of them - for one patient, for one encounter.  Who thinks the physicians are actually going to look through all of the entries at these two links, much less the corresponding pages for other diagnosis codes.  If you click on a link, scroll down after the page loads.  This is taken from the links I provided in my first post at the top of the page.

http://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14/M10-
http://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14/M1A-

One level higher:
http://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14

Somewhere I have the web addresses of software that can "read" the doctor's note written in the EMR and pull out key words.  Hopefully these programs will eventually be customized to read through the ICD-10 code listings - such as those for Gout - and match the keywords found in the doctor's notes with the words in the code listing.  Even if the software search can't find an exact match, presenting the doctor (or biller / coder) with a list reduced to five or so choices is better than having to go through the lists presented at the links above.  Again and again and again and again and ...

But a good half of our clients are not using EMRs and have no intention of doing so.  The have no access to the automatic ICD-09 to ICD-10 translators that the EMRs contain.  And they have no type-written notes for a software algorithm to "read" and then search through the ICD-10 lists.  How are they going to be specific with the codes in 12 months and still see patients?  There may not be time enough for them to do both.  I expect a good many doctors in this situation to join a doctors' group so they can just practice medicine and let someone else worry about the coding and billing.

gwenyth.bethan

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Re: ICD-10 Begins
« Reply #6 on: October 05, 2015, 10:11:48 AM »
I'm just curious. How is the shift to ICD-10 going so far in your organization? Do you like the change?

Michele

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Re: ICD-10 Begins
« Reply #7 on: October 05, 2015, 12:38:53 PM »
I can't say I like the change but I tend to not like change in general.  :)  So far we have gotten a couple rejections for non specific codes but that's all.  The next several months will be training our providers to use more specific ICD10 codes.  So far just some minor turbulence.   8)
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RichardP

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Re: ICD-10 Begins
« Reply #8 on: October 05, 2015, 02:17:42 PM »
I think it would be helpful if those who get non specific codes rejected would list them here over the next couple of weeks - along with the carrier that did the rejecting.

Medicare states that, for the next year, they will not reject these non specific codes if they are in the correct code family - but state that it is up to the individual commercial carriers whether to follow Medicare's lead or not.  I think it will help impress our clients of the seriousness of this change-over if we can provide "evidence" that non specific codes are being rejected.

kristin

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Re: ICD-10 Begins
« Reply #9 on: October 05, 2015, 06:45:57 PM »
Richard, you said:
Quote
But a good half of our clients are not using EMRs and have no intention of doing so.  The have no access to the automatic ICD-09 to ICD-10 translators that the EMRs contain.  And they have no type-written notes for a software algorithm to "read" and then search through the ICD-10 lists.  How are they going to be specific with the codes in 12 months and still see patients?  There may not be time enough for them to do both.  I expect a good many doctors in this situation to join a doctors' group so they can just practice medicine and let someone else worry about the coding and billing.

In my office, we do not use an EMR, we use Medisoft. In March of 2014, we upgraded to Version 19, which came pre-loaded with ICD-10 codes. The problem is like we discussed, that many of them are for unspecified codes. I also purchased an ICD 10 mappings book at the same time, and have spent the last year since ICD-10 was put off in 2014 slowly adding all the specified codes that I knew we would need, minus some of the bigger groups of them, like fractures. When I redid our superbills, if there was an equivalent mapping, I listed that. If there wasn't, I just listed the dx description, like gout, and left the space for the code blank, so that my doctor can write in the specifics, and I can then find the code needed in Medisoft, and select it. This system has worked great since Oct. 1. That way, I don't feel that I am "coding" so much as I am helping to "code", since I am not a certified coder. I copied pages out of my mappings book and put them in a binder for certain codes that have lots of choices, such as Gout, Ulcer, Diabetes, Fractures, etc. That way I can easily reference it, and add codes to the system as needed. I don't see the need to add every single code, if we may never use it for our specialty

I would think that most non-EMR softwares being used offer the same thing that Medisoft does, with the built-in codes to map to. And while I have heard of cases where doctors have retired or joined group practices with coders to avoid ICD-10, I think that they are really not giving it a chance. So far, it really has been very easy.

What made me really happy was checking claim status today for BCBS and Medicare, and finding out that a random selection of claims from Thursday have already been processed and paid, so I feel much better about the insurance companies being ready now too.

RichardP

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Re: ICD-10 Begins
« Reply #10 on: October 05, 2015, 07:42:17 PM »
I asked (rhetorically):  How are they going to be specific with the codes in 12 months ... ?
Kristin responded:  ... so that my doctor can write in the specifics ...

I provided two links to the ICD-10 codes for gout above.  Pick a code at random.  Look at all the detail written there that your doctor would need to provide in his note to you before you would be able to exclude all other codes and pick the one you just picked at random.

How is the doctor going to know what that detail needs to be, and write it down, if he has no access to the information provided at those two links - either by having no access to those links, or to an ICD-10 book(s), or to the codes provided in a PM system such as Medisoft?  Or, maybe he has access to the information but no time (or inclination) to read through it to find the specifics of what he needs.

What specifics are your clients going to write for Gout?  And suppose they say "middle finger" but don't specify which hand?  What code will you choose, or will you get back to your client for clarification?.  How many codes will you need to request clarification for, and how long will it take your client to get back to you?  We have discussed here frequently the fact that any codes submitted for payment must be backed up by what is written in the chart.  So you can't arbitrarily pick which hand in the example above.  Your code will need to reflect what is in the chart.  And if no hand is specified in the chart, you can't bill for that particular procedure until one is specified.

Michele says she has already received rejections for some non specific codes.  So, to stick with the example of Gout, we are probably going to end up defaulted to a code for Gout that is specified, rather than non specific, but at the most general level possible - even if that doesn't provide all of the detail available about the Gout for that particular encounter.  But - we are still left with the question of how to best respond when we need an up/down, left/right/ back/front, specific digit, and the client has not provided that information.

I'm starting to think that the solution may be a page with several pictures of a skeleton on it, front and back, and maybe side to side - for the provider to simply circle the appropriate location for whatever code he has selected.  A picture is worth a thousand words, and all that.  That can be attached to the fee slip they forward to billing - unless the billing is forwarded electronically.  We already have separate sheets for radiology and what-not attached to the main fee slip when they come to us - so a sheet with skeletons on it would not be that much of a change.

That is where I am coming from, and at this point my thoughts are only theoretical.  But they will need to cease being theoretical in a year. 

Michele

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Re: ICD-10 Begins
« Reply #11 on: October 06, 2015, 05:54:20 AM »
I should have been more specific in my post.  I guess it's not only the drs who have to learn!  We use our system for many of our providers but we also bill out of other systems as well.  We've only gotten a total of 3 rejections so far.  Two of them were from the PMS system edits, not the insurance carrier. The other was a clearinghouse rejection.  So technically we have gotten no rejections from insurance carriers yet. 
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RichardP

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Re: ICD-10 Begins
« Reply #12 on: October 06, 2015, 07:36:06 PM »
Thanks for that clarification Michele.

PMRNC

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Re: ICD-10 Begins
« Reply #13 on: October 09, 2015, 06:34:42 AM »
My pediatric clients all went for training on documentation and ICD-10, they went different place, some online, some were at conferences, but all of them learned about diagnosing to the highest level of specificity with ICD-10, They were even given sheets and apps on their devices to help. The apps I've seen are pretty neat as they would pop up questions when a particular diagnosis was put in. I'm not a coder either, but I think if providers were on top of this and took advantage of all the educational tools they were given they will be fine with diagnosis and a lot of technology has been added to allow them to do that and remind them to document.

I'd even go as far as saying that I think those doctors won't need coders. If I had to choose between one of my clients with coding over a CPC, my money is on my client (literally. LOL)
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